Improving the yield of preoperative parathyroid localization: technetium Tc 99m-sestamibi imaging after thyroid suppression. Surgery 2002 Dec;132(6):968-74; discussion 974-5
Date
12/20/2002Pubmed ID
12490843DOI
10.1067/msy.2002.128609Scopus ID
2-s2.0-0036915699 (requires institutional sign-in at Scopus site) 32 CitationsAbstract
BACKGROUND: Preoperative localization is essential for successful directed, minimally invasive or reoperative parathyroidectomy. Standard technetium Tc 99m-sestamibi imaging is the most sensitive modality for localization. We reviewed our experience with (99m)Tc-sestamibi imaging and specifically investigated the effect of thyroid suppression on repeat imaging of patients who had initially nonlocalizing scans.
METHODS: . The records of patients who underwent (99m)Tc-sestamibi imaging during evaluation for primary hyperparathyroidism were reviewed. A subset of patients with initially nonlocalizing scans underwent thyroid suppression with either thyroxin or liothyronine and then had their scans repeated.
RESULTS: Ninety-nine patients with primary hyperparathyroidism underwent (99m)Tc-sestamibi imaging followed by parathyroidectomy (initial operation, 78; reoperation, 21). Successful parathyroid localization was obtained on standard imaging in 67 patients. Fourteen of 32 patients who had nonlocalizing (99m)Tc-sestamibi imaging studies underwent an additional scan after thyroid suppression. In 10 of 14 patients (71%), repeat (99m)Tc-sestamibi imaging after thyroid suppression successfully localized abnormal parathyroid tissue.
CONCLUSIONS: Thyroid suppression may improve the yield of (99m)Tc-sestamibi imaging in patients with hyperparathyroidism who have an initially nonlocalizing study. This diagnostic strategy may be helpful in patients motivated to undergo a directed, minimally invasive operation, as well as in the evaluation of patients for reoperative parathyroidectomy.
Author List
Royal RE, Delpassand ES, Shapiro SE, Fritsche HA Jr, Vassilopoulou-Sellin R, Sherman SI, Gagel RF, Evans DB, Lee JEAuthor
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
HumansHyperparathyroidism
Nickel
Parathyroid Glands
Preoperative Care
Radiopharmaceuticals
Retrospective Studies
Technetium Tc 99m Sestamibi
Thyroxine
Titanium
Tomography, Emission-Computed, Single-Photon
Triiodothyronine